California voters passed a law two years ago that allows terminally ill people to take lethal drugs to end their lives, but controversy is growing over a newer rule that effectively bans that option in the state’s eight veterans homes

California voters passed a law two years ago that allows terminally ill people to take lethal drugs to end their lives, but controversy is growing over a newer rule that effectively bans that option in the state’s eight veterans homes

Proponents of medical aid-in-dying and residents of the Veterans Home of California-Yountville — the largest in the nation — are protesting a regulation passed last year by the California Department of Veterans Affairs, or CalVet, that requires that anyone living in the facilities must be discharged if they intend to use the law.

That’s a position shared by most — but not all — states where aid-in-dying is allowed. As more U.S. jurisdictions consider whether to legalize the practice, the status of terminally ill veterans living in state-run homes will loom large.

“It would be a terrible hardship, because I have no place to go,” said Bob Sloan, 73, who suffers from congestive heart failure and other serious cardiac problems. He said he intends to seek medical aid-in-dying if doctors certify he has six months or less to live.

The idea that gravely ill patients should have access to experimental medicines is morally unassailable. A bill before Congress to establish a national “right to try,” however, is the wrong way of going about it.

Passed by unanimous consent in the Senate last fall and endorsed with gusto by President Donald Trump in his State of the Union speech, the legislation would allow Americans to use yet-to-be-approved drugs that have passed only preliminary safety tests — without permission from the Food and Drug Administration. The bill is similar to right-to-try laws that have been passed by 38 states.

Though grounded in compassion, the bill would do little to actually improve the prospects of terminally ill patients — and may put some of them at greater risk. For one, its underlying assumption — that the FDA gets in the way — is plain wrong. The FDA already allows “compassionate use” of medicines still in development, approving almost every one of the applications it receives within days, if not hours. Any delays patients face usually come from the drugs’ developers.

Doctors routinely show up for work when they are sick. I’ve done it myself, seeing patients while I had pneumonia, or suffering with severe hip pain. And I’ve been complicit many other times, watching physician colleagues work through similar and sometimes worse illnesses without demanding that they go home.

Of course, none of us want to spread illness and harm our patients. So we tell ourselves it will be fine if we just wear a mask and gloves, take ibuprofen, and march on through the day.

The letter was drafted by Alison Bateman-House, associate professor of medical ethics at NYU Langone Health, along with some of her colleagues. It is addressed to the leaders of the House Committee on Energy and Commerce, the committee currently considering a so-called “right-to-try” bill. The letter was circulated for online signatures on Thursday, and organizers said they planned to send the letter on Feb. 5.

In August the Senate passed a right-to-try bill sponsored by Sen. Ron Johnson, which is now sitting in a House committee. The bill would allow patients with life-threatening conditions access to drugs that have not been approved by the Food and Drug Administration. FDA Commissioner Scott Gottlieb has expressed reservations about the bill, but President Trump seems to support it.

Roger Kligler writes, “I’m a doctor with incurable stage 4 prostate cancer. When my suffering becomes intolerable, I hope my doctors will permit me the option to end it peacefully with medical aid in dying. Medical aid in dying gives mentally capable, terminally ill adults with six months or less to live the option to request a prescription medication they can choose to take in order to end unbearable suffering by gently dying in their sleep.”

Roger Kligler writes, “I’m a doctor with incurable stage 4 prostate cancer. When my suffering becomes intolerable, I hope my doctors will permit me the option to end it peacefully with medical aid in dying. Medical aid in dying gives mentally capable, terminally ill adults with six months or less to live the option to request a prescription medication they can choose to take in order to end unbearable suffering by gently dying in their sleep.”

When I was in my 40s, I watched my mother and my father-in-law suffer agonizing deaths from cancer. I remember thinking, “That’s not the way I want to die.” As an internist, I have treated patients in the office and the hospital, including intensive care units. I took over the primary care of patients who were terminally ill when specialists were no longer able to help them. I passionately believed that my professional responsibilities included caring for my patients at the ends of their lives.

I was involved in most aspects of pain control and hospice care. For some patients, I provided palliative sedation to unconsciousness, which means giving intravenous morphine to someone who is terminally ill and has excruciating, uncontrolled pain, essentially putting them to sleep until death occurs. I have had discussions with patients about putting them on a ventilator and later disconnecting it to end prolonged dying processes. I helped patients decide whether or not to undergo treatment when the alternative was death. However, when a terminally ill patient with cancer asked me to help him die peacefully to end his suffering, I was afraid that I might lose my license or, worse still, end up in prison. I’m embarrassed to say that I declined to give him a lethal prescription, as I put my needs ahead of his. That is a morally compromised position.

Ira Byock writes, “Centuries from now, one of the things our era will be known for is the plague of dying badly. A growing number of physicians believe that one solution is helping their dying patients choose to end their lives. I disagree.”

Ira Byock writes, “Centuries from now, one of the things our era will be known for is the plague of dying badly. A growing number of physicians believe that one solution is helping their dying patients choose to end their lives. I disagree.”

I’m proud of being a physician and a lifelong political progressive. I ardently believe in human rights. But there are some things doctors must not do. Intentionally ending patients’ lives is chief among them.

Prolonged suffering before death emerged as a public health crisis in the mid-20th century. This first-world scourge, so persistent that few dare to imagine it can be eradicated, is a direct result of modern medicine’s original sin: believing that we can vanquish death. Given doctors’ success at saving lives threatened by severe injuries and infections, they presumed they could overmaster death. Yet despite the prowess of 21st-century medicine, my colleagues and I have yet to make a single person immortal. Instead, we have condemned countless incurably ill patients to needless anguish.

While every state except Maryland — which is excluded because it has a different Medicare payment system — had at least one hospital punished, some got off comparatively lightly. Of hospitals in Alabama, Kansas, Massachusetts, Missouri, Ohio, Texas and nine other states, 16 percent or fewer of the institutions were punished. (State summaries can be found at the bottom of this post; a searchable list of individual hospitals penalized is here.)

The penalties — now in their fourth year — were created by the Affordable Care Act to drive hospitals to improve the quality of their care. Each year, hundreds of hospitals lose 1 percent of their Medicare payments through the Hospital-Acquired Conditions Reduction Program.